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PROVINCE OF NOVA SCOTIA

DELAYED REGISTRATION OF BIRTH

99000851

TO THE REGISTRAR GENERAL OF NOVA SCOTIA

I hereby make application for the Registration of Birth of Ralph CampbellParks Sex Male

Date of Birth October 23, 1922 Place of Birth HalifaxCounty of Halifax

Name of Father Jesse parks MAIDEN NAME of Mother Mary Wrin

Were the Parents married at the time of the Birth? Yes

Residence of Father when child was born Halifax Present address of Father Deceased

Occupation of Father at Birth of child Place of birth of Father Halifax

Race Name and present address of Physician in attendance at birth

Signature of Applicant Ralph Campbell Parks Address of Applicant 8437 East Sage Drive, Scotsdale, Arizona, USA Date 18 August 1981

Relationship of Applicant to child Self

AFFIDAVIT

IN THE MATTER of the application for the Registration of the Birth of Ralph CampbellParks

Born at Halifax in the County of Halifax

That Ralph CampbellParks Whose Birth is sought to be registered was

born at Halifax Halifax County on October 23, 1922

My knowledge of the fact and date of such Birth is based on the following Circumstances:

Baptismal certificate

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